The objective of this guideline is to provide healthcare professionals with practical guidance on the use of anti-D Ig as immunoprophylaxis to prevent sensitisation to the D antigen during pregnancy or at delivery for the prevention of HDN.
Prior to the availability of anti-D immunoglobulin (anti-D Ig), the incidence of Rh D alloimmunisation in D negative women following two deliveries of D positive, ABO-compatible, infants was approximately 16%, and haemolytic disease of the fetus and newborn (HDN) due to anti-D was a significant cause of morbidity and mortality (Urbaniak & Greiss, ). Following routine post-partum administration of anti-D Ig, the rate of alloimmunisation dropped to approximately 2%. A further reduction in the sensitisation rate ranging from 0·17 to 0·28% was achieved by introducing routine antenatal prophylaxis during the third trimester of pregnancy (Tovey et al., ,b; Huchet et al., ; Mayne et al., ; MacKenzie et al., ). Associated with this reduction in sensitisation is a reduction in mortality associated with HDN, from 46/100 000 births to 1·6/100 000 births (Pilgrim et al., ).
These findings contributed to the National Institute for Clinical Excellence (NICE) recommendation that all D negative pregnant women who do not have immune anti-D, should be offered additional routine prophylaxis with anti-D Ig during the third trimester of pregnancy (NICE, , ).
Declaration of Interests
The BSH paid the expenses incurred during the writing of this guidance. None of the authors had conflicts of interest to declare. All authors have made a declaration of interests to the BSH and Task Force Chairs which may be viewed on request.